Provider Demographics
NPI:1376759621
Name:LABORATORIO CLINICO Y BACTERIOLOGICO LAUREL INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO LAUREL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:IVELISSE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-995-3888
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1728
Mailing Address - Country:US
Mailing Address - Phone:787-995-3888
Mailing Address - Fax:787-995-3888
Practice Address - Street 1:SANTA JUANITA AVE LAUREL Q-35
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-995-3888
Practice Address - Fax:787-995-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR521291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031434Medicare PIN